Ever since the Greek poet, Simonides, wrote in 400 BC that "one day she is all smiles and gladness…but the next she is dangerous to look at or approach", blokes have painted themselves as the innocent victims of premenstrual syndrome.

But preliminary research showing PMS is worse for women who are in a relationship with a man than for those in a same-sex relationship provides a clue that men may be the missing link in their partner's distress.

Professor of women's health psychology, Jane Ussher, is investigating how men experience and respond to premenstrual syndrome as part of a wider study into women's experiences of PMS.

"We're looking at how does a partner's reaction to a woman's premenstrual stress impact on her, how much do relationship issues actually cause or make worse a woman's premenstrual distress," says Ussher, who's the director of gender, culture and health research at the University of Western Sydney.

Ussher, a 20-year veteran of PMS research, says men need to be better equipped to respond to a partner's symptoms and appreciate the role they can play in magnifying or mitigating the pain. She says when women in an earlier study were asked to give an account of their PMS, many gave an account of a relationship issue.

"What we found is rather than reporting symptoms [of PMS], women gave an account invariably of an issue with their partner," she says.

"How is it a woman attributes a problem to PMS when often [it is] a really quite reasonable reason to be upset or angry or frustrated about what's happening in a relationship?

"You get someone who tells me about a terrible argument with their partner where he's being really unreasonable and she says to me 'that's PMS'.

"I could say to her, 'why is that not your partner being unreasonable?'"

Women in same-sex relationships reported the same symptoms but experienced less distress.

"Women in lesbian relationships feel much less distressed by their symptoms even though they're at the same level, and they feel much more able to cope," Ussher says.

Dr Sue Reddish, the medical director at the Jean Hailes Medical Centre for Women, says men need to be better educated about the female reproductive system from boyhood.

"Young men seem to know about PMS but it's a big joke," she says. "They have a girlfriend and she's in bad mood because of her PMS. They don't understand how disabling and devastating it can be."

Ussher is developing a study with Relationships Australia to see if couple counselling works as an intervention for PMS. If relationship counselling helps, Ussher says it could reduce the need for more radical forms of treatment such as hormone therapy, anti-depressants and, in severe cases, surgery.

"There's no research looking at couple counselling focusing on PMS and it's a black hole that needs to be filled," she says.

What is PMS?

A joke recently doing the email rounds describes PMS as shorthand for "permissible man slaughter", "preposterous mood swings" and "punish my spouse". In reality, premenstrual syndrome is a mood disorder which occurs in the second half of a woman's cycle and resolves with her period, Reddish says.

Also known as late luteal phase dysphoric disorder, PMS is listed on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

About five per cent of women have a severe form of PMS known as premenstrual dysphoric disorder (PMDD). This can be associated with extreme aggression, anxiety and blood sugar disturbances. It can lead to psychosis, suicide and even murder.

PMS is much less spectacular for most women, but an estimated 80 per cent of Australian women experience one or more of 150 recognised monthly symptoms including tiredness, irritability and "wanting to be alone".

John Eden, associate professor in reproductive endocrinology at the University of New South Wales and the Royal Women's Hospital in Sydney, says PMS is the result of a dialogue between hormones and neurotransmitters in the brain. Then there's lifestyle, or what he calls the "black box where you put everything else in".

"If you've got a high-powered job and a lot of stress in your life, that aggravates everything," Eden says.

Into the black box also goes the western "superwoman" obsession, says Ussher, which may go some way to explaining why PMS, like eating disorders, is predominantly a western phenomena.

Ussher says it's part of the time-honoured western tradition of blaming female distress on their reproductive bodies.

"The notion of the premenstrual phase of the cycle as a kind of psychological disturbance is not there in Asian countries, in India, among Afro-Caribbean women," she says.

What causes PMS?

"The short answer," Eden says, "is there isn't one cause. There's not a single mechanism for PMS."

What is known is that PMS is linked to the ovulatory cycle, so no ovulation means no PMS. This is why the condition doesn't occur in prepubertal girls, during pregnancy and breastfeeding or after menopause.

"Mid-cycle you get a peak in luteinising hormone, which is a hormome from the pituitary gland and one of the things that triggers ovulation, and when the ovary releases the egg you have an oestrogen peak," says Reddish.

"If you're not pregnant the ovary fizzles out and you get the corpus luteum (the structure that develops from the follicle which released the egg), which produces a progesterone peak."

This would suggest that PMS is associated with a drop in oestrogen and rise in progesterone, but it's not that simple, Reddish says. In fact, studies have shown that there's no difference in hormone levels between women with PMS and those without. Rather, differences are found in the brain.

"There are numerous studies that have asked, do women make too much progesterone, too much oestrogen, too little of this, too much of that," says Eden, who describes PMS as primarily a brain phenomenon.

"But there's no scientific evidence to support that…It's more to do with how your brain reacts with your hormones."

Specifically, the changes in hormone levels trigger symptoms through the brain's neurotransmitters, and levels of serotonin, noradrenaline and GABA (gamma-aminobutyric acid) can vary in women with different forms of PMS.

A recent study by a US team used brain imaging to demonstrate that neural activity actually changes during the menstrual cycle.

Reporting in the Proceedings of the National Academy of Sciences, the researchers from Cornell University in New York said brain patterns mapped before a woman's periods showed greater activity in the frontal regions that help control emotions. After menstruation, the extra brain activity disappeared.

"The results…demonstrate that brain processes can change across the menstrual cycle," the researchers write, saying this suggests the brain is compensating for hormonal changes to maintain a constant emotional state.

How to handle PMS  some options

Non-medical

Exercise

Stress reduction and lifestyle modification

Charting cycles and planning activity to fit in with mood changes

Relationship counselling

Medical

The contraceptive pill

Hormone treatment

Anti-depressant and anti-anxiety medication

Oophorectomy (radical surgey to remove the ovaries. Only performed in exceptional cases.)

Women behaving really badly

Left untreated or ignored, PMS can have devastating consequences.

Criminologist Dr Patricia Easteal of the Australian National University has investigated the relationship between PMS and recent cases of manslaughter and addresses the issue in her 2001 book, Less Than Equal.

Easteal says PMS is largely ignored in the Australian court system except as a mitigating factor, in contrast to the UK, where it's been used to downgrade murder charges to manslaughter. The cases, which occurred in the 1980s, used medical records, diaries and criminal records to link the actions of the women to their menstrual cycle.

In one case, a barmaid who killed a co-worker argued that PMS "turned her into a raging animal each month", while lawyers for another woman said hypoglycaemia caused by PMS led her to kill her lover by ramming him with her car.

Esteal rankles at the suggestion that PMS is an excuse for female violence against men.

"Like battered woman syndrome, people will say it's just an excuse for a woman to kill her partner," she says. "I don't accept that at all, in those cases I believe these are real physical conditions caused by severe hormonal imbalances."

She says PMS hasn't featured largely in Australian criminal cases, largely because it isn't recognised as a medical condition in the same way as epilepsy or diabetic hypoglycaemia, which are much more commonly used as criminal defences.

PMS and the law in the UK

1981:

Twenty-nine-year-old barmaid Sandie Craddock got off a murder charge after stabbing another worker to death when she pleaded diminished responsibility because of PMS.

The judge accepted the argument that PMS was a mitigating factor in the incident because it turned Craddock "into a raging animal each month".

A review of Craddock's diaries showed that each of her past 30 convictions and multiple suicide attempts occurred around the same time of her menstrual cycle.

Craddock was found guilty of manslaughter, placed on probation and ordered to take progesterone treatment.

1981:

Christine English killed her married lover when she rammed him against a pole with her car after a fight.

The court was told English had an aggravated form of PMS which contributed to a drop in blood sugar and an over-production of adrenalin before the incident.

The court reduced the murder charge to manslaughter on grounds of diminished responsibility.

1988:

Twenty-year-old Anna Reynolds killed her mother by hitting her on the head with a hammer.

At her trial, it was argued that she suffered from PMS, which led to the temporary loss of control and impairment, reducing her culpability.

How PMS affects men

No, men don't get PMS, Ussher says.

She says there's no evidence that male moods are influenced by hormones and while male moods may fluctuate, there's no predictable cycle. However, some research has shown that men's mood cycles can follow that of their partners, and this isn't just a case of male "me-too-ism".

"If you're a man living with a woman who has a very clear mood cycle then it's inevitable you're going to be affected by that, but it doesn't mean you have PMS."

Living with a premenstrual partner can be a bewildering, frustrating and often isolating experience for men.

"Male partners particularly don't know what to do," Ussher says. "They report they feel confused, they feel that whatever they say is wrong. A lot of them just really don't understand how it can be happening. Some of the men feel quite helpless."

In contrast, women in same-sex relationships have told Ussher they feel their partner is more supportive and they feel less need to "get away from them premenstrually".

"The way we're interpreting it is firstly that women are more understanding about premenstrual changes because they often get them themselves," she says. "So women are less judgmental of it, whereas male partners are much more likely when they don't understand to blame the woman.

"There's also lots of research showing women are more likely to take supportive roles in relationships anyway…so if you're a premenstrual woman with a woman partner your partner's more likely to say, put your feet up, go and have a bath, don't worry about what you've got to do today."